Online DBT-Based Intervention Improves Emotion Regulation in Chronic Pain

Online dialectical behavioral therapy plus standard care for chronic pain is associated with significantly greater improvement in emotion regulation and psychologic outcomes compared with standard care alone, according to study results published in JAMA Network Open.

In a 2-arm, parallel-group randomized controlled trial conducted from March 2023 to September 2024, researchers in Australia randomly assigned adults with chronic pain (≥3 months) 1:1 to receive either online dialectical behavioral therapy plus standard care (n=45) or standard care alone (control group; n=44). All patients had a weekly pain intensity score of at least 3 on a 10-point Numeric Rating Scale. The intervention included 8 weekly 90-minute therapist-guided group video conference sessions, app- and handbook-based self-directed learning modules, and weekly text message reminders.

The primary outcome was emotion dysregulation at 9 weeks, measured by the Difficulties in Emotion Regulation Scale (score range, 18-90). Secondary outcomes included emotion dysregulation, pain intensity, depression, anxiety, stress, post-traumatic stress symptoms, well-being, sleep, and pain interference as measured by the Patient-Reported Outcomes Measurement Information System Pain Interference instrument.

Among 89 patients included in the final analysis, the mean (SD) age was 51.5 (14.2) years, 83% were women, and the mean pain duration was 15.9 years. The most common pain types were neuropathic pain (54%), low back pain (44%), and arthritis (37%). Baseline characteristics between the intervention and control groups were generally well balanced. Most (81%) patients in the intervention group completed at least 7 of 8 sessions, 89% completed the 9-week assessment, and 81% completed the 21-week assessment.

At 9 weeks, patients in the intervention group had a significantly greater and clinically meaningful reduction in emotion dysregulation compared with those in the control group (mean difference [MD], -4.88; 95% CI, -9.20 to -0.55; P =.03), with the effect sustained at 21 weeks (MD, -5.38; 95% CI, -9.78 to -0.97).

The intervention was associated with significant improvements in depression at 9 weeks (-8.82 points; P <.001) and 21 weeks (-7.14 points; P =.007). Similar findings were observed for anxiety at 9 weeks (-8.41 points; P =.003) but not at 21 weeks. Patients in the intervention group also experienced significant improvement in stress, post-traumatic stress symptoms, sleep, and well-being at 9 weeks, though moderate effect sizes were noted and between-group differences were no longer significant by week 21.

Further analysis indicated the intervention led to improvements in pain intensity. However, the researchers observed no significant reduction in pain intensity until 21 weeks (-1.31 points; 95% CI, -2.12 to -0.49; P =.002). There was no significant between-group difference in pain interference noted at any time point.

No serious adverse events were reported. Among patients in the intervention group, 3 experienced mild adverse events that were related to a preexisting medical condition.

Limitations of this study include a lack of socioeconomic diversity, a predominance of women in the cohort, and a short follow-up period.

The researchers concluded, “Improving emotion dysregulation may therefore be a necessary task in the therapeutic model for chronic pain to provide sustained changes in this pervasive outcome.”

Disclosure: Some study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Clinical Pain Advisor